BACKGROUND AND AIMS:The combination of atezolizumab plus bevacizumab (Atz/Bev) has radically changed the treatment strategy for advanced hepatocellular carcinoma (HCC) but raises questions. Our objectives were to determine survival outcomes and safety in a real-life multicenter French cohort, to investigate the on-treatment prognostic value of the bioinflammatory RECA score, and to perform a matched comparison with patients who previously received tyrosine kinase inhibitors (TKIs). METHODOLOGY:A retrospective analysis of 109 consecutive patients enrolled from September 2020 to January 2023 and a post matched comparison with a TKI cohort ( n  = 79) by the propensity score matching method. RESULTS:The Atz/Bev population was mainly nonviral disease patients (69%) with Child-Pugh grade A (90%), performance status 0/1 (90%), and Barcelona Clinic Liver Cancer stage B (38%) or stage C (62%) classification. After a median follow-up of 6.5 months (3.6-11.7), overall survival (OS) was 13.0 (5.1-28.7) months. OS was independently associated with metastasis, increased alkaline phosphatase, and serum bilirubin levels. Treatment-related adverse events were reported in 78% of patients, mostly grade 1 or 2. The RECA score clearly revealed two different prognosis groups after three cycles. No difference in OS was observed after matching between sequential treatment with TKIs and Atz/Bev. CONCLUSION:This real-life study highlights the importance of liver function when using Atz/Bev combination and the necessity of identifying predictive markers of response to HCC therapies. Our findings suggest a change in practices, with a marked proportion of intermediate stages, and support the on-treatment prognostic value of an inflammatory score.

In Sensoa's HCV prevalence study, only 1 of 260 test results was positive (0.38%) and this was an HIV co-infected patient.The Ex Aequo's HCV prevalence study yielded no positive test results.The HIV prevalences were 1, 15% (Sensoa) and 1, 3% (Ex Aequo) and the syphilis prevalence was 2, 5% (Ex Aequo).Conclusion: There is a big knowledge gap of HBV and HCV infections in the MSM community in Flanders.More awareness campaigns that focus on transmission, disease process, treatment and vaccination need to be created that also target people with a low educational level.The prevalence of hepatitis C infection and other STD's was low in the MSM population studied of 500 participants.Presumably a young MSM population that voluntarily has themself tested represents a rather low risk profile for HCV infection.HCV prevalence may be higher in an older population and/or in an illegal environment where more risk factors for HCV infection co-exist and that is more difficult to reach.However, given the high workload and low case finding, an on-site screening approach cannot be recommended.

Background Direct-acting antivirals (DAAs) therapy against hepatitis C viral (HCV) infection has markedly improved the sustained viral response. However, recent studies have suggested an unsuspected high rate of hepatocellular carcinoma (HCC) recurrence. Patients and methods A retrospective case–control study was carried out to investigate the impact of DAAs on tumor recurrence in patients with complete response to HCC treatment within our HCV-related cirrhosis cohort. Patients who received [group 1 (G1), n=22] or not [group 2 (G2), n=49] a DAAs therapy were matched 1 : 2 for age, sex, liver function, HCC stage, and treatment. Results Initial HCC were mostly Barcelona Clinic Liver Cancer stage A (95% G1, 94% G2). Sustained viral response with DAAs was achieved in 86% of patients. After a similar median overall follow-up time with similar radiologic surveillance after HCC treatment, 41% of patients developed radiologic tumor recurrence in G1 versus 35% of patients in G2 (P=0.7904). There was no significant difference in time to progression between the two groups [12 (9–16) months G1 vs. 14 (8–21) months G2, P=0.7688], or Barcelona Clinic Liver Cancer stage at recurrence. However, the interval between HCC treatment and antiviral therapy was significantly different among DAAs patients with recurrence and those without recurrence [7.0 (2.5–9.0) months vs. 36.0 (9.0–58.0) months, P=0.0235, respectively]. Conclusion In our case–control study, HCV therapy with DAAs does not accelerate or prevent early HCC recurrence compared with untreated patients. The rate of recurrence, time to progression, and HCC pattern are similar. Early DAAs treatment (<12 months) after HCC cure should be discouraged considering the HCC recurrence rate during this period.

We have read with great interest the commentary “Response to ‘the flexible therapeutic approach to the BCLC B stage’: time for scoring systems?” by Adhoute et al. on our recent review about the treatment of intermediate stage HCC. [1] Galle P.R. Tovoli F. Foerster F. Worns M.A. Cucchetti A. Bolondi L. The treatment of intermediate stage tumours beyond TACE: From surgery to systemic therapy. J Hepatol. 2017; 67: 173-183 Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar The treatment of intermediate stage tumours beyond TACE: From surgery to systemic therapyJournal of HepatologyVol. 67Issue 1PreviewTreatment of hepatocellular carcinoma (HCC) is dependent on the stage of the disease. Intermediate stage HCC encompasses the largest subgroup of patients with the disease, and is characterized by substantial heterogeneity. The standard therapeutic approach, transarterial chemoembolization (TACE), is probably over-used and may not be appropriate for all patients with intermediate stage HCC. In patients with extensive tumour bulk, multi-nodular spread or impaired liver function, TACE may not be optimal and other treatments can be considered as a first-line treatment. Full-Text PDF Response to ‘the flexible therapeutic approach to the BCLC B stage’: Time for scoring systems?Journal of HepatologyVol. 68Issue 1PreviewWe read with interest the review by Galle et al. concerning the therapeutic strategies for intermediate stage hepatocellular carcinoma (HCC).1 The heterogeneity of this group is highlighted, yet only transarterial chemoembolization (TACE) is recommended in the guidelines. However, some (Barcelona Clinic Liver Cancer) BCLC B patients may not benefit from TACE. Thus, in this review other therapeutic approaches are discussed, based on an exhaustive review of the literature, from transplantation to the most recent systemic treatments, such as immunotherapy. Full-Text PDF